Akira Oshima

Effect of interferon therapy on the incidence of hepatocellular carcinoma and mortality of patients with chronic hepatitis C: a retrospective cohort study of 738 patients.

The effect of interferon on the long‐term clinical outcome of patients with chronic hepatitis C remains unclear. This study included 594 patients with chronic hepatitis C who received interferon‐α therapy (Interferon group) and 144 patients with chronic hepatitis C who did not receive interferon (Control group). The patients in the Interferon group were classified into the following three groups based on the response of the serum aminotransaminase level of the patient during and after completion of the therapy protocol: sustained responders (n = 175), transient responders (n = 165), and non‐responders (n = 254). The age, sex, serum aminotransaminase level, platelet count, histological staging, hepatitis C virus (HCV) subtype, and HCV concentration at baseline were adjusted with the Cox proportional hazards model. The length of follow‐up for assessment of the risk for developing hepatocellular carcinoma (HCC) was 57.2 ± 13.9 months in the Interferon group and 67.7 ± 28.7 months in the Control group. Multivariate analysis showed that interferon therapy decreased the risk for developing HCC by 48% compared with that in the Control group (P = 0.064). The older the age, being male, having a low platelet count, and higher histological stage were independent factors associated with the development of HCC. The hazard rate ratio for development of HCC in the sustained responders, transient responders, and non‐responders was 0.16 (95% confidence interval [CI]: 0.04–0.62), 0.27 (95% CI: 0.09–0.79), and 0.74 (95% CI: 0.37–1.48), respectively. During follow‐up, 18 patients in the Interferon group died (10 from liver‐related diseases) and 17 patients in the Control group died (10 from liver‐related diseases). No sustained responder or transient responder in the Interferon group died of liver‐related disease. The cumulative survival rates of the Interferon and Control groups were nearly identical during the first 5 years following diagnosis. Thereafter, the cumulative survival rate of the Control group declined, resulting in an 8‐year survival rate in the Interferon and Control groups of 97% and 81%, respectively (P = 0.061). Similar trends were seen in the survival analysis of those who had died of liver disease: the 8‐year survival rates of the Interferon and Control groups were 98% and 88%, respectively (P = 0.32). Our study demonstrated that interferon therapy significantly lowered the incidence of HCC among patients with chronic hepatitis C who showed sustained normalization and among patients who showed transient normalization of the serum aminotransferase level after completion of interferon therapy. The survival analyses and determination of cause of death suggested that interferon therapy improves the long‐term survival of chronic hepatitis C patients who respond to this therapy, possibly by decreasing mortality from liver‐related diseases. Int. J. Cancer 87:741–749, 2000.

Incidence and mortality from stomach cancer in Japan, Slovenia and the USA

The mortality and incidence from stomach cancer were compared in Japan (a country with a high incidence where there was full application of mass screening during this period) and 2 countries with no screening policy: the USA (with a very low incidence) and Slovenia (with an intermediate rate). The registered cases of stomach cancer were from the Osaka Cancer Registry, the Slovenian National Cancer Registry and the Surveillance, Epidemiology, and End Results (SEER) registries in the USA. In the period 1975–95, the age‐adjusted incidence rate (/100,000) of stomach cancer declined in the 3 countries, as follows: Japan, from 76.0 to 53.0 in men and 38.4 to 21.3 in women; Slovenia, from 40.2 to 24.1 in men and 16.6 to 10.8 in women; and the USA, from 9.5 to 6.9 in men and 4.3 to 2.9 in women. During the same period, the age‐adjusted mortality rate declined, as follows: Japan, from 60.2 to 34.2 in men and 30.5 to 14.1 in women; Slovenia, from 37.7 to 21.2 in men and 13.8 to 9.0 in women; the USA, from 5.6 to 4.7 in men and 2.5 to 2.3 in women. In the period studied, specific trends on incidence and mortality with a cohort effect occurred only in Japan: analysis by the age period‐cohort model confirmed that the decline has occurred since the generations born in 1910. The trend therefore corresponds to unplanned prevention through changes in environmental factors occurring since the early 20th century. The study of stage‐specific incidence rates confirmed the declining trend for regional cancer, whereas there was an increase in the incidence of localized cancer, associated with a period effect in 1975–95. This is attributed to the policy of early detection of stomach cancer, with the inclusion of intramucosal lesions of favorable prognosis and explains why mortality decreased faster than incidence during the period.

A long‐term follow‐up study of patients with gastric cancer detected by mass screening

This report is based on 1,139 patients with gastric cancer (GC) detected by mass screening conducted by the Center for Adult Diseases, Osaka during 1961–1985. Early GC totalled 527 patients and advanced GC totalled 612 patients. In 859 patients curative resection was performed. Their vital status was traced yearly and six patients were lost to follow‐up. Relative survival rates of screening‐detected GC patients were 69–70% and almost constant after 5 years from operation/diagnosis. The survival curve in which only death from GC was counted as a death was almost equal to the relative survival curve in its shape and value. The hazard rates of screening detected GC patients decreased rapidly within 7 years and remained low after 7 years. It was confirmed by this long‐term follow‐up study that about two thirds of GC patients detected by screening were successfully cured of their disease.

Neuroblastoma trends in Osaka, Japan, and Great Britain 1970-1994, in relation to screening.

Japan pioneered and has maintained a nationwide mass screening programme for neuroblastoma since 1985 without prior evaluation among a target population. Convincing population‐based evaluation of the ongoing programme has also been very limited because a population‐based registry for childhood cancer has not been in operation. This report describes trends in incidence of and mortality from neuroblastoma in Osaka Prefecture, Japan, using Great Britain as an external control, between 1970 and 1994. Incidence and mortality rates were comparable between the 2 areas before the beginning of screening in Osaka. However, incidence rates were markedly increased in Osaka, especially among children younger than 1 year, from 25.9 per million children during 1970–1979 to 240.2 during 1991–1994, while age‐standardized incidence rates for metastatic tumours among children aged 1 year or above did not decrease after introduction of the programme. Age‐standardized mortality rates per million were unchanged at 3.9 (1970–1979) and 4.1 (1991–1994) in Osaka and 5.7 (1971–1979) and 5.0 (1991–1994) in Great Britain. Cumulative incidence rates among those up to 15 years old progressively increased from 103.4 per million (1970–1979) to 350.0 (1991–1994) in Osaka, though cumulative mortality rates did not decrease: 52.0 and 57.5, respectively. Corresponding figures in Great Britain were 101.0, 115.1, 78.6 and 70.1, respectively. The present findings show little beneficial effect of the screening programme.

Prospective evaluation of diagnostic accuracy of gastrofiberscopic biopsy in diagnosis of gastric cancer

The accuracy of gastrofiberscopic biopsy in diagnosis of gastric malignancies has been evaluated by studying operative and postmorten findings and clinical follow‐up data in linkages at Osaka Cancer Registry, Japan, after an average of 7.7 years. Satisfactory data were obtained in follow‐ups of all 1331 patients examined. There were only 31 (3.7%) false‐negative diagnoses of malignancy among 858 patients diagnosed as having benign lesions, and only three (0.6%) false‐positive diagnoses among 473 patients diagnosed as having malignant tumors. The false‐negative diagnoses were most frequent in cases of elevated types of early cancer, advanced cancer of type 4 and leiomyosarcoma, or in cases located in the posterior wall and in the antrum. The three benign lesions that were diagnosed as malignant by biopsy were all associated with active ulceration, indicating that care is necessary in taking biopsy specimens of ulcerated lesions. From these findings the sensitivity and specificity of the gastrofiberscopic biopsy method for detection of gastric malignancies were calculated to be 93.8% and 99.6%, respectively, and the overall accuracy for all the patients was 97.4%. These results reconfirm that gastrofiberscopic biopsy is very useful for diagnosis of gastric malignancies.

Statistical Estimation of the Number of Breast Cancer Patients with Disabilities Resulting from Surgery

BackgroundThe prolongation of the post-operative life of cancer patients brings new medical demands. The purpose of this paper is to estimate the total number of women patients with breast cancer who will have disability resulting from surgical treatment from 2000 to 2020 in Japan.MethodsThe estimation was carried out using four indices: the number of cases of women diagnosed with breast cancer, the proportion of surgical operations, the frequency of disability from surgical treatment, and the crude survival rate of the patient group.The crude survival rates of surgically-treated breast cancer patients were estimated by the Weibull model. The frequencies of iatrogenic disabilities were calculated from several reports of complaints of pain in the chest wall or axilla and lymphedema of the arm, and 95% confidence intervals were calculated by the Monte Carlo simulation.Results and DiscussionThe number of women patients with disability from breast cancer treatment from 2000 to 2020 was estimated to be 42,016 (95% CI: 41,236, 42,796) people in 2000 and 72,514 (95% CI: 71,196, 73,832) people in 2020 for pain in the chest wall or axilla, and 22,486 (95% CI: 22,148, 22,823) people in 2000 and 38,692 (95% CI: 38,094, 39,290) people in 2020 for lymphedema of the arm. Treatment supports required for the disability are medication and social support. Cancer patients with disability after treatment need long-term support in their daily life.

The Patterns of Care Study and Regional Cancer Registry for non–small-cell lung cancer in Japan

PURPOSEnWe examined whether the data registered in the Japanese Patterns of Care Study (PCS) for patients with non-small-cell lung cancer (NSCLC) represent the actual situation of radiotherapy in Japan. The Osaka Cancer Registry (OCR) data, forming the largest database of a regional cancer registry in Japan, were adopted for use as a benchmark against the national condition.nnnPATIENTS AND METHODSnWe examined 906 patients of the PCS treated between 1995 and 1997 and 845 patients of the OCR registered between 1988 and 1992. The investigation was made by descriptive statistical methods to measure age, stage, combined treatments, type of treated hospitals, and prognosis. Furthermore, the national averages (NAs) of the PCS process (PCS NA) were also calculated to compensate for the imbalance in the PCS data sampling.nnnRESULTSnThe mean age was 67.3 +/- 10.1 in PCS and 64.4 +/- 11.0 in OCR (p < 0.001), 67.2 in PCS NA. The male ratio was 84.2% in PCS and 84.0% in OCR (p = 0.411), 84.1% in PCS NA. The ratio of the patients at the localized stage was 24.2% in PCS and 15.6% in OCR (p = 0.001), 21.1% in PCS NA. The ratio of surgery combined was 24.2% in PCS and 28.9% in OCR (p = 0.026), 25.3% in PCS NA. The ratio of chemotherapy combined was 50.1% in PCS and 67.5% in OCR (p = 0.001), 47.4% in PCS NA. Because the definitions of institution classification and period of prognostic inquiry were different between the two databases, the 3-year survival rates were calculated for reference. In the nonsurgery group, it was 20.3% in PCS and 11.3% in OCR (p = 0.001), and in the surgery group it was 52.5% in PCS and 42.2% in OCR (p = 0.057).nnnRESULTSnAges in the two databases were inconsistent. Sex distributions were consistent. Surgery and chemotherapy were more frequently performed for the OCR patients, and more patients at more advanced stages were also observed in OCR. The PCS NAs of sex, stage, and ratio of surgery combined were at the midpoints between those of PCS and OCR. The survival rate of NSCLC patients in the OCR was significantly inferior to that in the PCS. The follow-up rate of the PCS was lower than that of the OCR. The general features of PCS data showed similarity to OCR data, and the results of the PCS NAs suggested the effectiveness of this method to adjust the sampling imbalance in PCS.

Time trends of HBeAg prevalence rate.

わが国のHBVキャリアにおけるHBe抗原陽性率の年次推移を明らかにするために,年齢階級別,出生コーホート別に観察した.1) 1977年1月から84年3月の間に,大阪府赤十字血液センターが取扱ったHBs抗原陽性の献血者,男23,560人,女8,659人を調査対象とした.2) 性,年齢階級別にHBe抗原陽性率の年次推移を観察すると,男女とも近年HBe抗原陽性率が低下しつつあったが,特に,10歳代,20歳代でその傾向が著しかった.3) HBe抗原陽性率は,年齢とともに低下したが,同じ年齢階級でも出生年代が若くなるにつれて,HBe抗原陽性率は低くなった.4) 以上から,わが国のHBVキャリアにおけるHBe抗原陽性率は,今後も低下傾向を持続すると推測された.